Sodium Nitroprusside Dihydrate is indicated for-

• Immediate reduction of blood pressure
• Producing controlled hypotension to reduce bleeding during surgery 
• Treatment of acute heart failure to reduce left ventricular end-diastolic pressure, pulmonary capillary wedge pressure, peripheral vascular resistance and mean arterial blood pressure 

Heart Failure

Hypertension (High Blood Pressure)

Initiate infusion of sodium nitroprusside at a rate of 0.3 mcg/kg/min, and titrate every few minutes until the desired effect is achieved OR the maximum recommended infusion rate of 10 mcg/kg/min has been reached 

Most common adverse reactions are hypotension and cyanide toxicity

Hypotension (Low Blood Pressure)

Cyanide Toxicity

• Cyanide Toxicity: Prolonged use may lead to cyanide toxicity, especially in patients with impaired renal function. Monitor for signs such as metabolic acidosis, altered mental status, and hemodynamic instability.
• Thiocyanate Toxicity: Monitor for signs of thiocyanate toxicity, particularly in patients with prolonged use or impaired renal function. Symptoms include confusion, hyperreflexia, and seizures.
• Hypotension: Adjust the infusion rate carefully to avoid excessive hypotension.
• Renal Function: Use with caution in patients with impaired renal function, as accumulation of thiocyanate may occur.
• Hematologic Effects: Monitor for methemoglobinemia, especially in patients with pre-existing conditions or concurrent medication use.
• Pregnancy and Lactation: Use only if the potential benefit justifies the potential risk to the fetus. Use with caution during lactation.